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1.
Successful immune reconstitution decreases leukemic relapse and improves survival in recipients of unrelated cord blood transplantation. 总被引:3,自引:0,他引:3
Robertson Parkman Geoff Cohen Shelly L Carter Kenneth I Weinberg Bernadette Masinsin Eva Guinan Joanne Kurtzberg John E Wagner Nancy A Kernan 《Biology of blood and marrow transplantation》2006,12(9):919-927
Allogeneic hematopoietic stem cell transplantation (HSCT) is established therapy for selected patients with acute leukemia. After transplantation, antileukemic immune responses are believed to eliminate residual leukemia cells and decrease the likelihood of relapse. However, the clinical effect of successful antigen-specific immune reconstitution after HSCT on the likelihood of leukemic relapse and overall survival is not known. Pediatric recipients of unrelated cord blood transplants who underwent transplantation for acute leukemia were sequentially evaluated for their development of antigen-specific T-lymphocyte immunity to herpes viruses. The clinical effect of a positive antigen-specific response on relapse-free survival was determined. The presence of an antigen-specific response resulted in a relapse-free survival advantage (P = .0001), which was primarily due to a decrease in leukemic relapse (P = .003). Proportional hazards modeling for time to relapse and time to relapse or death defined 3 variables that were strongly associated with a poor outcome: female gender, poor remission status before transplantation, and negative antigen-specific T-lymphocyte proliferation. Notably neither acute nor chronic graft-versus-host disease had any effect on the incidence of leukemic relapse. Successful antigen-specific immune reconstitution after unrelated cord blood transplantation results in decreased leukemic relapse and improved overall survival. 相似文献
2.
R Parkman 《Pediatric annals》1991,20(12):677-681
3.
To determine if and how clonidine and tricyclic antidepressants affect gastric contractility. Guinea pig fundic and antral circular muscle strips were studied in vitro. The effects of clonidine or amitriptyline added in graded concentrations on contractions to electric field stimulation (EFS), acetylcholine (ACh), and SP in the presence of N(epsilon)-nitro-l-arginine methyl ester (l-NAME) were studied. EFS produced frequency dependent contractions of fundic and antral muscle that were abolished by atropine or tetrodotoxin (TTX). ACh contractions were abolished by atropine but not TTX. Clonidine reduced contractile response to EFS but had no effect on ACh contractions. The threshold concentration of clonidine to inhibit EFS contractions was lower in the fundus than in the antrum. Amitriptyline reduced contractions to both EFS and ACh but not to SP. The threshold concentration of amitriptyline to inhibit EFS contractions was lower in the antrum than in the fundus. Both clonidine and amitriptyline affect gastric contractility. At threshold concentrations, clonidine affects fundic contractility whereas amitriptyline affects antral contractility. Clonidine affects gastric contractility in response to EFS but not to ACh, suggesting alpha-2 receptors on cholinergic nerves that reduce ACh release. Amitriptyline inhibits gastric contractility to EFS and ACh suggesting an inhibitory muscle effect. 相似文献
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Sudeep S Sodhi Jin-Ping Guo Alan H Maurer Gerald O'Brien Radhika Srinivasan Henry P Parkman 《Journal of clinical gastroenterology》2002,34(1):34-39
GOALS: To determine the prevalence, severity, and outcome of gastroparesis after heart and lung transplantation (HLT). STUDY: Ten patients (five women; age range, 27-57 years) underwent HLT at Temple University Hospital from 1996 to 1999. The charts of these patients were reviewed, including results from gastric emptying scans and upper endoscopies. Symptoms were assessed with a standardized questionnaire. RESULTS: The indications for HLT included pulmonary hypertension in six patients, Eisenmenger syndrome in two, and dilated cardiomyopathy and congenital heart disease in two. Four patients died before the start of this clinical analysis. The six surviving patients constituted our study population. The patients' posttransplantation follow-up period ranged from 1.4 to 4.4 years (average, 2.6 years). Five patients (83%) were symptomatic with nausea, vomiting, and postprandial abdominal distension. Solid phase gastric emptying was delayed in all five patients with mean gastric retention of 93% at 2 hours (normal <50%). Patients generally did not respond to prokinetic agents. Four patients required pyloroplasty with J tube placement for symptom control, nutrition, and delivery of immunosuppressive medication. CONCLUSIONS: There is a high prevalence of symptomatic gastroparesis in patients after HLT. The gastroparesis is severe and often resistant to prokinetic agents. 相似文献
7.
Nonulcer dyspepsia 总被引:1,自引:0,他引:1
Parkman HP 《Current Treatment Options in Gastroenterology》1998,1(1):15-19
Opinion Statement Dyspepsia is a heterogeneous symptom complex with differing symptom presentations, underlying pathophysiology and available
treatments. Patients older than 50 years and those who have “alarm” symptoms or signs (eg, weight loss, dysphagia, vomiting, anemia, or heme-positive stool) should undergo an initial endoscopic evaluation. Empiric
treatment without diagnostic testing may be used in the initial approach to young patients without alarm symptoms. For patients
presenting with uncomplicated dyspepsia, initial testing for H. pylori is appropriate. If present, H. pylori infection is generally treated and symptoms are followed. In patients who do not have H. pylori infection or do not respond to H. pylori treatment, initial treatment with an H2 blocker or promotility agent is appropriate empiric therapy. In some patients, gastroesophageal
reflux disease (GERD) presents atypically with primarily dyspeptic symptoms. In these patients, a trial of gastric acid suppressant
may help implicate GERD. For patients with nonulcer dyspepsia (ie, dyspeptic symptoms with negative endoscopy), prokinetic therapy may be the most effective empiric treatment. 相似文献
8.
American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis 总被引:17,自引:0,他引:17
Parkman HP Hasler WL Fisher RS;American Gastroenterological Association 《Gastroenterology》2004,127(5):1592-1622
This literature review and the recommendations herein were prepared for the American Gastroenterological Association Clinical Practice Committee. The paper was approved by the Committee on May 16, 2004, and by the AGA Governing Board on September 23, 2004. 相似文献
9.